# Thematic analysis of narrated reasons for suicidal ideation among Chinese adolescents in psychological counseling

## TL;DR

This study explores the reasons Chinese adolescents express for suicidal thoughts in counseling, highlighting the complex mix of academic, family, and mental health pressures.

## Contribution

The study provides a novel thematic analysis of real-world counseling data to uncover interconnected factors driving suicidal ideation in Chinese adolescents.

## Key findings

- Five key themes were identified: self-cognitive dissonance, academic pressure, family factors, mental health issues, and weak social ability.
- These themes form a reinforcing cycle where external pressures worsen internal vulnerabilities.
- The findings emphasize the need for multi-systemic interventions targeting cognition, family, and school environments.

## Abstract

Adolescent suicidal ideation is a critical public health concern in China, yet the subjective drivers of these thoughts remain insufficiently understood.

This study sought to elucidate the reasons Chinese adolescents articulate for suicidal ideation in real‐world counseling contexts.

We performed a reflexive thematic analysis of therapy transcripts from 51 adolescents (aged 10–19 years; 38 females and 13 males) seeking counseling for depressive symptoms, recruited from the psychiatric outpatient departments of Grade A tertiary hospitals in China.

The analysis identified five interconnected themes: (1) self-cognitive dissonance, (2) academic pressure, (3) family factors, (4) mental health issues (referring to the direct impact of their mental health symptoms), and (5) weak social ability. The findings reveal that these themes operate as a synergistic system, creating a reinforcing cycle where external pressures exacerbate internal vulnerabilities. For these adolescents, suicidal ideation appears to emerge from the complex interplay of academic, familial, social, and intrapsychic distress.

The results provide a nuanced understanding of how multiple risk factors synergize in this population and underscore the necessity of adopting integrated, multi-systemic interventions that concurrently target the adolescent’s cognitions, their family dynamics, and the school environment to effectively address this multifaceted crisis.